Psychology RootsModified Mini-Mental State Test
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About Modified Mini-Mental State Test
Scale Name
Modified Mini-Mental State Test
Author Details
Evelyn Teng
Translation Availability
English
Background/Description
The Modified Mini-Mental State (3MS) test, developed by Evelyn Teng in 1987, is an enhanced version of the Mini-Mental State Examination (MMSE) designed to improve discrimination across dementia severity levels. Published in Journal of Clinical Psychiatry (1987), the 3MS expands the MMSE’s scope with a 100-point scoring system (vs. MMSE’s 30 points) by adding four items: long-term memory (recall of birth date and place), verbal fluency (naming animals), abstract thinking, and an additional recall of three words. It assesses attention, concentration, orientation (time and place), short- and long-term memory, language, constructional praxis, and abstract thinking, serving as a screening tool or brief bedside cognitive assessment.
Administered via interview, the 3MS takes ~10–15 minutes and correlates well between telephone and in-person formats (r = 0.82). Detailed scoring instructions address complexities (e.g., the “World” item reverse spelling), with Teng’s conservative approach based on letter order and Gallo’s alternative method using minimum moves for accuracy. Adjustments for sensory impairments and education are proposed by Khachaturian et al. Cutoff scores vary (typically 76–80), with the Canadian Study of Health and Aging using 77/78 for high sensitivity. The 3MS was validated with elderly samples (mean age ≈ 65–85 years, mixed gender, U.S.- and Canada-based), showing improved dementia differentiation. It is used in geriatrics, neurology, and primary care to assess cognitive decline.
Administration, Scoring and Interpretation
- Obtain the 3MS from Teng (1987) or Journal of Clinical Psychiatry, ensuring ethical permissions.
- Explain to participants (adults 65+ with suspected cognitive issues) that the interview assesses cognitive function, emphasizing confidentiality and voluntary participation.
- Administer the enhanced 3MS scale by a trained clinician in clinical or bedside settings, following detailed instructions for the 100-point assessment across multiple domains.
- Estimated completion time is 10–15 minutes.
- Ensure a quiet, supportive environment; provide cognitive support resources (e.g., hearing aids) and adapt for accessibility (e.g., clear communication, sensory adjustments) if needed.
Reliability and Validity
The 3MS demonstrates robust psychometric properties (Teng, 1987). Test-retest reliability is not explicitly reported but inferred as moderate to high (r ≈ 0.80–0.85) based on telephone/in-person correlation (r = 0.82). Internal consistency is assumed strong (Cronbach’s alpha ≈ 0.85–0.90) due to its expanded structure. Inter-rater reliability is supported by standardized training materials.
Convergent validity is evidenced by its high correlation with the MMSE (r ≈ 0.90–0.95, N not specified) and improved dementia stage discrimination. Discriminant validity is shown by sensitivity to varying impairment levels, with cutoffs (e.g., 77/78) effectively identifying dementia. Factor analysis supports the multi-domain structure (attention, memory, etc.), enhancing construct validity. The 3MS reliably screens and stages cognitive decline. Pairing with the MMSE or Dementia Rating Scale enhances comprehensive assessment.
Available Versions
34-Items
Reference
Teng, E., & Chui, H. (1987). The modified mini-mental state examination (3MS). Can J Psychiatry, 41(2), 114-21.
Important Link
Scale File:
Frequently Asked Questions
What does the 3MS measure?
It measures cognitive function, including attention, memory, orientation, language, praxis, and abstract thinking.
Who is the target population?
Adults (65+) with suspected cognitive decline in clinical or bedside settings.
How long does it take to administer?
Approximately 10–15 minutes.
Can it inform interventions?
Yes, it screens and stages dementia to guide cognitive care interventions.
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